RESEARCH ARTICLE

Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients Evgeni Mekov1*, Yanina Slavova1, Adelina Tsakova2, Marianka Genova2, Dimitar Kostadinov1, Delcho Minchev1, Dora Marinova1, Maya Tafradjiiska1 1 Clinical Center for Pulmonary Diseases, SHATPD ‘Sveta Sofia’, Sofia, Bulgaria, 2 Central Clinical Laboratory, UMHAT ‘Alexandrovska’, Sofia, Bulgaria * [email protected]

Abstract Introduction 31–77% of patients with COPD have vitamin D deficiency and insufficiency, with results being highly variable between studies. Vitamin D may also correlate with disease characteristics. OPEN ACCESS Citation: Mekov E, Slavova Y, Tsakova A, Genova M, Kostadinov D, Minchev D, et al. (2015) Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients. PLoS ONE 10(6): e0129080. doi:10.1371/ journal.pone.0129080 Academic Editor: Yunchao Su, Georgia Regents University, UNITED STATES Received: February 4, 2015 Accepted: May 4, 2015 Published: June 5, 2015 Copyright: © 2015 Mekov et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: This work was supported by Medical University—Sofia, Sofia, Bulgaria (grant number 15D/2014, project number 22-D/2014) (http://mu-sofia. bg/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist.

Aim To find out the prevalence of vitamin D deficiency and insufficiency in patients with COPD admitted for exacerbation and a risk factors for lower vitamin D levels among comorbidities and COPD characteristics.

Methods 152 patients were studied for vitamin D serum levels (25(OH)D). All of them were also assessed for diabetes mellitus (DM) and metabolic syndrome (MS). Data were gathered also for smoking status and exacerbations in last year. All patients completed CAT and mMRC questionnaires and underwent spirometry.

Results A total of 83,6% of patients have reduced levels of vitamin D. 42,8% (65/152) have vitamin D insufficiency (defined as 25–50 nmol/L) and 40,8% (62/152) have vitamin D deficiency (7.0 mmol/L OR 2-h plasma glucose >11.1 mmol/L during an oral glucose tolerance test (OGTT) OR HbA1c>6.5% OR on therapy [27]; • Presence of prediabetes: fasting plasma glucose 5.6–6.9 mmol/L OR 2-h plasma glucose 7.8– 11.0 mmol/L during an OGTT OR HbA1c 5.7–6.4% [27];

PLOS ONE | DOI:10.1371/journal.pone.0129080 June 5, 2015

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Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients

• Presence of MS: at least 3 of the following: 1. Elevated waist circumference >102 cm in males, >88 cm in females; 2. Triglycerides >1.7 mmol/L (or on therapy); 3. HDL FEV130% predicted); very severe (50% vs 50%

35,49

90

FEV150 nmol/l

% patients with vitamin D 25–50 nmol/l

% patients with vitamin D 50nmol/l in overweight group (28,9%) and lowest—in the underweight group (0%) (Table 2). We conclude that BAI is better predictor for hypovitaminosis D than BMI. Our study did not find correlation between vitamin D level and number of fractures (p = 0.166). However fractures were significantly more frequent in patients with vitamin D 50 nmol/l (0,73 vs 0,24, p = 0.007). The low level of vitamin D is related to decreased bone density in patients with COPD [9,37] and data from NHANES III study showed correlation between airflow obstruction and osteoporosis [38]. A positive relationship is found between the severity of COPD and the number of fractures [39], but our study did not find difference between the number of fractures in

PLOS ONE | DOI:10.1371/journal.pone.0129080 June 5, 2015

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Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients

Table 3. Mean level of vitamin D and prevalence of vitamin D deficiency and insufficiency in patients with COPD. Authors

N

Mean level (nmol/L)

% patients with

Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients.

31-77% of patients with COPD have vitamin D deficiency and insufficiency, with results being highly variable between studies. Vitamin D may also corre...
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